Surgical Needle with Enhanced Ultrasound Reflectivity

ABSTRACT

Notches in a surgical needle with means to retain small amounts of air or other reflective material while being passed through tissue will significantly enhance the ultrasound reflectivity to enhance the response to ultrasonic probing to provide an enhanced image.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. provisional patentapplication No. 61/685,390 filed 16 Mar. 2012 and entitled SurgicalNeedle with Enhanced Ultrasound Reflectivity, and U.S. provisionalpatent application No. 61/686,694 filed 10 Apr. 2012 and entitledSurgical Needle with Added Ultrasound Reflectivity, the disclosures ofboth are incorporated by reference.

BACKGROUND OF THE INVENTION

This invention relates to a medical device that provides enhanced imageand response to an ultrasound signal and more particularly to a surgicalneedle having geometric features that provides an enhanced image andresponse.

Ultrasonic imaging has long been used in medical practice to provideimages not only of body organs and parts but also of the medicalinstruments and in particular needles that are used in connection withvarious medical procedures.

For example, ultrasonic imaging is used to guide a medical needle into abody part to effect a biopsy, to inject material or liquids, to accessfluid collection for sampling or drainage, to obtain vascular access andto access the urinary and biliary tracts. Ultrasonic imaging is alsoused to place a needle at a tumor or other body structure for subsequentsurgical removal or to ablate the tumor with a variety of energies ormethods.

A major limitation on the ultrasonic guided intervention or proceduresare the inability to image the medical instrument or needle adequatelyin many circumstances. The visibility of the needle is stronglydependent on the particular geometrical relationship between thetransducer that provides the ultrasonic beam and the reflective surfaceof the instrument. The amount of ultrasonic energy reflected from theinstrument toward the transducer (an ultrasonic echo sensor) determinesthe quality of the image of the instrument on the monitor. If the needleis in the plane of the interrogating ultrasonic beam and horizontal tothe face of the sensing transducer, or perpendicular to the direction ofthe incident beam, the reflected energy is optimized and a usablevisible image is obtained. However, as the needle becomes lessperpendicular to the direction of the incident beam, lesser amounts ofultrasonic energy are reflected to the sensor and the instrument isimaged poorly or not at all.

The optimal geometric relationship is difficult to maintain in all butfairly limited applications of ultrasonic guided interventions. Itbecomes nearly impossible to maintain the optimum geometry in manyinstances because of intervening organs or structures. This results inpoor visualization of the instrument, procedure time is lengthened andcomplexities are created which would not be present if the needle wereeasily seen.

Multiple passes with a needle may have to be made before it can bevisualized causing tissue damage within adjacent organs or structuresand creating the potential of bleeding and other complications. Thereare times when the physician is able to visualize the target lesionquite well but not the needle or other instrument. Moving the sensingtransducer can result in the needle being imaged but the image of thetarget lesion is lost. A series of trial and error maneuvers areemployed. Breathing motion of the patient further complicates theprocess.

This problem has been addressed by a large number of proposed designs,including those shown in U.S. Pat. No. 4,869,259, No. 4,977,897, No.5,048,530, No. 5,081,997, No. 5,213,569, No. 5,221,269, No. 5,383,466,No. 5,490,521, No. 5,611,345, No. 5,766,135 and No. 5,769,795. Theproblem has also been addressed in the inventor's U.S. Pat. No.6,053,870 which is incorporated herein by reference, and which is adefinite improvement over other prior art devices.

The devices shown in the above referenced patents are intended toenhance ultrasonic visibility. Some of these devices are complex andexpensive to manufacture. Some of these devices are difficult tomanipulate within the patient such as the square rectangular shapedneedle suggested in U.S. Pat. No. 5,611,345. Furthermore, many of thedevices only marginally enhance ultrasonic visibility.

SUMMARY OF THE INVENTION

In brief, one embodiment of this invention is a surgical needlemanufactured of stainless steel or some other material which provides aninterface with human tissue that results in an ultrasonic echo. One ormore notches are created in the sidewall of the needle. The notch may bea wedge-shaped, triangular, multifaceted, trihedral or other shapednotch defining at least a first and second walls in the sidewall of thelumen. Where these walls are planar, the plane of each wall intersectsthe axis of the needle at an acute, obtuse or right angle. The wallscreated by the notch provide a large amount of reflective surface area.Additional indentations or ridges within the notch will enhance thereflectivity and create additional air containing pockets or siteswithin these notches to enhance reflectivity even more.

In another embodiment, the needle may be solid or the needle may have alumen and the notches may or may not extend into the lumen. The notchesmay be only on one side so as to preserve a smooth side to deliveryelectrical current, heat, cold, radiofrequency, irreversibleelectroporation, and the like uniformly to select tissue or tumors, orthe notches may be only on one side for other reasons including limitingthe reflectivity.

In operation, when an embodiment of a needle is inserted into a patient,the surface of the needle will reflect incident ultrasonic energy indirections that are determined by the needle sidewall and the notchwalls. The result is to reflect ultrasonic energy at a substantial rangeof angles. When the needle is inserted into a patient, sufficient amountof air is entrained so as to provide small air, CO2, microspheres,contrast agent, etc., bubbles which form on or are trapped in thenotches. These air bubbles provide a further sound velocity contrastwith tissue so as to enhance wide angle reflection of an incidentultrasonic energy pulse. In this fashion, the ultrasonic echo sensor canhave a wide variety of spatial orientations relative to the needle andyet receive a strong enough ultrasonic echo to provide a usable anduseful image of the needle. Alternatively, air, CO2, microspheres,contrast agent, amongst other materials may be purposefully placedwithin the notches or applied to the notches in one of several methodsto enhance the visibility of the notches. Doing so acts to enhance orpromote the entrainment and retention of these additional reflectivesurfaces within the notches.

While the notches may be triangular, transverse, oval, multifaceted, orany other shape, the construction of the notches is important in otherrespects. A notch that is able to retain small amounts of air while theshaft traverses tissue will simply reflect better than a notch that isnot able to retain the air. In U.S. Pat. No. 6,053,870, small holes fromthe notch extend into the lumen of the needle and supply air to thenotch to enhance the reflectivity. This works very well in someapplications, but is problematic in others especially if the lumen ofthe needle is used to inject or aspirate fluids through the tip of theneedle. The holes in the sidewall limit the amount of suction one canapply to the lumen and needle tip by aspirating air or other materialthrough the side holes. In the case of injecting fluids, the fluids mayexit the holes in the base of the notches rather than the tip of theneedle causing the fluid to be deposited at least partially at a siteother than the intended one. Hence, one embodiment of the needle of thecurrent invention is to provide a shape, configuration, or treatment,including the filling of the notch with a substance that comprises airbubbles or other reflective material, that will enhance the retention ofthese small quantities of air within the notch and enhance reflectivitywithout having the base of the notch extend into the lumen as in the'870 patent above. Another technique to prevent the entrained air orother reflective material from being displaced from the notches is tocreate small cavities in the sides or floor of the notches that more orless protect the entrapped air from being displaced. Overhanging edgesof the notches also would create small reservoirs where the air or otherreflective materials could reside without being displaced. Other methodswill be described below.

While the reflectivity will largely a result of reflections from a faceof the notch, whether that face be at an acute, obtuse, or right angleto the axis of the needle shaft, the features described herein willenhance the visibility by ultrasound by providing additional reflectivesurface within the notch that will directly reflect the ultrasound beamand provide a nidus for attachment of small amounts of air to reflectthe ultrasound beam. These additional features will allow visualizationof the needle even at the steepest of angles.

The depth of the notch is also important as is the shape. Both the depthand the shape of the notch will affect the retention of small amounts ofair to enhance the reflectivity. Other features, aspects and advantagesof the present invention can be seen on review of the drawings, thedetailed description and the claims which follow.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1 is a longitudinal sectional view of a prior art device showing aparticular notch arrangement at the distal portion of a needle.

FIG. 2 is a top view of a prior art device showing notches in thesidewall of the needle.

FIG. 3 is a plan view of a needle with three notches with indentationsand ridges in the bottom of the notches.

FIG. 4 is a needle with indentations in the sidewalls of the notches.

FIG. 5 is a longitudinal sectional view of the needle of the currentinvention with notches filled with a substance comprising small airbubbles.

FIG. 6 is a longitudinal sectional view of the needle of the currentinvention with the notches filled with a substance comprising reflectiveparticles. Alternatively, the substance may be reflective without theparticles being present. Additionally, a reflective substance withreflective particles may at least partially fill the notch.

FIG. 7 is a longitudinal sectional view of a needle with notches ofdiffering configurations that have overhanging surfaces that createcavities that harbor the air bubbles when the needle is inserted intothe tissue and prevent the sliding action of the needle from dislodgingthe air bubbles from the notches.

DETAILED DESCRIPTION OF THE INVENTION

In some examples the medical instrument, and in particular a needle,will provide enhanced imaging in a wide range of orientations betweenthe axis of the needle and the ultrasonic echo sensor.

According to some examples of the needle, it is possible to provide thisenhanced imaging in a design that is simple and inexpensive tomanufacture and relatively simple to operate.

The advantages achieved by various examples of a needle made accordingto the invention are important in order to assure maximum usage of theinvention in a large number and a wide variety of applications where anultrasonically identified needle is important.

Examples of needles made according to the invention can create noadditional risk of trauma to tissue. According to some examples, theneedle has enhanced imaging characteristics but also maintains itsfunction to deliver a variety of energies without compromising theshape, intensity, or any other parameter of the energy field.

There are inevitable operational trade-offs in the choice of differentneedle design features to achieve the above interrelated operationalcharacteristics.

Accordingly, a surgical needle made according to the invention providesan enhanced ultrasonic visibility while also achieving one or more thefollowing characteristics: low cost, simple structure, high degree ofsafety, a high degree of uniform energy deposition within the tissues,and the avoidance of complicated procedures or new techniques with whichmedical personnel are not familiar.

The following description will typically be with reference to specificstructural embodiments and methods. It is to be understood that there isno intention to limit the invention to the specifically disclosedembodiments and methods but that the invention may be practiced usingother features, elements, methods and embodiments. Preferred embodimentsare described to illustrate the present invention, not to limit itsscope, which is defined by the claims. Those of ordinary skill in theart will recognize a variety of equivalent variations on the descriptionthat follows. Like elements in various embodiments are commonly referredto with like reference numerals.

FIGS. 1 and 2 disclose a prior art surgical needle 10. A series ofnotches 14 near the distal end of the needle extend around substantiallyless than half the circumference of the needle. Each notch 14 is cutdeep enough so that over a small distance, there is an opening 12 whichprovides communication between the lumen 16 of the needle and the zonedefined by the notch, however in some embodiments there is nocommunication with the lumen.

The notch 14 is cut into the sidewall. The two wall faces 18, 20 providea relatively significant area to reflect incidence of ultrasonic energyand thus create an ultrasonic echo that can be received over asubstantial area. The reflectivity of the faces is enhanced by the airthat is siphoned from the lumen and into the notches when the needle isadvanced through the tissue. As the needle is advanced the tissueattaches to small air bubbles and displaces the air from the notches andthe air is spread along the shaft of the needle, enhancing the shaft.The air in the lumen is conveyed through the small holes at the base ofthe notches a re-fill the notches with air which rather dramaticallyenhances the reflectivity of the notches.

However, in the case in which the notch does not communicate with thelumen containing air, or in which the lumen contains fluid, the airinitially within the notches may easily be displaced out of the notchesrendering the notches not as reflective. The initial reflectivityenhancement provided by the air is lessened as the air initially presentwithin the notches is removed by manipulating the needle within thetissue. This may necessitate removing the needle, washing it off toclean out the notches, removing the water from the notches by tappingthe needle repeatedly, and then replacing the needle with air againpresent within the notches. This series of maneuvers is problematic andone major object of the present invention is to provide a means toretain the air bubbles within reflective notches in the needle sidewallso that the needle is visible by ultrasound after multiple passes andmaneuvers within tissue and overcome the limitations of the prior artdevice.

One method of solving the above problem would be to form the notcheswith a right angle or obtuse angle that would tend to retain the smallamounts of air within the notches as the needle is passed through thetissue. These angles and steep acute angles will retain more air thanmore shallow acute angles and cause the needle to be more visible underultrasound. The depth of the notches may also contribute to retention ofair, as the deeper the notch, the more likely small amounts of air willbe retained within the notches, and the more likely the needle will bemore visible by ultrasound.

The inventor has conducted experiments that confirm the above. Needleswith notches comprising steep angles, either right, acute, or obtuseangles were evaluated in a turkey breast model utilizing standardultrasound techniques, and all were very visible by ultrasound.Subsequently the turkey breast was immersed and covered in a water bath,the needles were agitated within the water bath to remove any airbubbles within the needle notches and then placed into the turkey breastwhile still under water. This latter maneuver prevented any air contactwith the needle notches before inserting them into the turkey breast.The ultrasound transducer was then also immersed and scanning wasperformed with the needle, the turkey breast, and the ultrasoundtransducer all under water. The needles and the needle notches were muchless visible than during the standard above water assessment. Thisindicates, if not proves, that much of the enhanced reflectivity is duenot to the angles of the face of the notch but to the presence of smallamounts of air within the notches of the needles.

Maneuvers, methods, and technology to enhance the reflectivity of theneedles by ultrasound hence should include means to enhance the presenceand retention of small amounts of air within the notches. Some of thesemeans are discussed subsequently. Others will be anticipated by thoseskilled in the art that read this description, but are intended to beincluded here within.

FIG. 3 is a plan view of a needle and demonstrates notches 14A, 14B, and14C with a base 29 that comprises small transverse indentations 32 andridges 31 that will add additional surfaces of reflectivity and alsoretain small bubbles of air (not shown) for reflectivity enhancement.Sound will be reflected from the transverse face 30, but the additionalindentations 32 and ridges 31 will enhance this reflectivity. The notch12A comprises only indentations 32. The notch 12B comprises only ridges31, and the notch 12C comprises both ridges 31 and indentations 32.These are oriented more or less transversely but may be oriented inother directions. While the transverse face 30 will reflect sound, theadditional reflectors within the notches will enhance soundreflectivity. The ridges 31 or indentations 32 may also be present inthe sidewalls or face of the notch, and may or may not be oriented moreor less perpendicular to the expected incident ultrasound waves.

FIG. 4 demonstrates a needle 10 with a notch 14 with indentations 32 inthe sidewalls of the notch 14 that provide a reservoir for bubbles ofair. These sidewall indentations 32 may provide additional reflectivity,but may just serve to resupply the notch 14 with reflective air bubblesafter the needle 10 passes through tissue and some of the initial airwithin the notches 14 is removed by the sliding action of the needle.Similarly, the indentations 32 may be placed in the floor 28 of thenotch 14 (not shown.)

FIG. 5 demonstrates a needle 10 with a notch 14 that is filled with asubstance 41 that contains air bubbles 40 suspended within the substance41. While the face of the notch 30 will provide reflectivity, thesesuspended air bubbles 40 will provide the reflectivity enhancement sothat the needle 10 will be visible even when the shaft of the needle isat very steep angles relative to the ultrasound beam. Coatings ofneedles with reflective surfaces are commercially available, but tendonly to enhance a needle that is not very reflective The coatings areusually comprised of a polymer, but may be any of several substances andmay contain small spheres of a reflective material. The additive effectof the transverse reflective face 30 and the reflective air bubbles 40within the notch 14 will reflect sound waves much better than a coatingover a smooth needle. The coated needles also tend not to slide throughtissue with ease as the coatings provide friction with the tissue thatmakes advancement and placement of the needle problematic. This designovercomes those problems by placing the reflective substance 41 or thereflective air bubbles 40 within the substance 41 within the notches andnot on the surface of the shaft of the needle.

FIG. 6 demonstrates a needle 10 with a notch 14 which is filled with asubstance 41 that comprises other reflective materials 42. This maycomprise particles of a reflective material 42 suspended in a substance41 that fills the notch 14 or the substance 41 that fills the notch 14may actually be the reflective material with different ultrasoundimpedance properties than tissue and the needle shaft. Additionally, inthe case of reflective particles 42 within a substance 41, the particles42 may be randomly oriented as in the case of notch 14E, or oriented ina consistent manner as in notch 14D. This may be accomplished byapplying a magnetic field, for example, or some other means to the notchduring the process of filling the notch 14D. Aligning the particles sothey are more or less parallel with the transverse face 30 may enhancethe reflectivity more than any other orientation. Notch 14F demonstratesdifferent sized particles 42. These are just examples of differentconfigurations and orientations. This configuration solves the problemscaused by coating the needle shaft discussed in the preceding paragraph.The substance which fills the notch may be one of many differentsubstances, and ideally the outer surface of the substance filling thenotch will be continuous with the outer surface of the needle shaftcreating a smooth transition from needle shaft to notch to needle shaft.This will essentially restore the cylindrical surface to the needleshaft by filling the notch and allow it to traverse tissue more easily.As well, there would be no concern that the reflective material would bedisplaced from the notch by the passage of the needle through tissue.Alternatively, the notch may be only partially filled with thereflective substance or substance which contains the reflectivematerial.

In FIG. 6, the notches 14 -of the needle are filled with a substance 41that will create enhanced echoes from the notch 14, but is also ofsimilar electrical conductivity as the needle. This substance ideallyhas echogenic properties as dissimilar as possible as the needle, butelectrical conductivity and energy transmissive qualities as close tothe metal needle as possible. This will allow the transmission anddeposition of an energy field of choice in a homogeneous manner withinthe chosen tissue.

FIG, 7 demonstrates a needle 10 with a notch 14 with overhanging edges50 of the notch 14 which provide a reservoir of sorts for the air toremain in when the needle is advanced through tissue. Possible differentshapes are illustrated in notches 14 a through 14 e but shapes andconfigurations are not limited to these configurations.

While not demonstrated herein, any combination of the above features mayenhance reflectivity even more. For example, small indentations andridges may be present within a notch that comprises a substance withultrasonic reflective materials.

Although this invention has been described in connection with particularembodiments, it should be understood that there would be variations onthe embodiment shown which would provide the advantage of the inventionthat are included in the teachings herein.

For example, reference is made throughout the specification in claims toa needle. However, it is conceivable that there may be certainsituations in which some cannula other than a needle wouldadvantageously employ the arrangement of this invention. It should beunderstood herein that a needle is defined to include such cannulas.

In certain incidences, it may be advantageous to utilize both thepassive method of providing means to enhance the residence of airbubbles within the notches as described in the preceding paragraphs, andthe active method of urging air, CO2, microspheres, contrast agent,etc., into the lumen of the device by pumping or some other means. Thismay be accomplished by utilizing a needle design with small holes in thebase of the notches and inserting a small amount of air, CO2,microspheres, contrast agent, etc., via a bulb or some other structureattached to the device, or a small air, CO2, microspheres, contrastagent, etc., -containing bladder, cartridge, or vessel in addition tousing ambient air.

Further, in utilizing ultrasound guidance to locate tumors and to placeprobes within or adjacent to the tumors, it is necessary to locate theneedle as has been described above. This can be successfully done withthe current invention. However, if probes are utilized to deliver anenergy field to the tumor or tissue, the notches in the needle whichprovide the enhanced ultrasonic visibility may cause the energy field tobe non uniform with irregular areas of more or less energy. In thiscase, it may be advantageous to place the notches facing away from thetumor and the transducer beam so that the smooth side of the needle isfacing the tumor or the tissue into which the energy is to be deposited.This can be accomplished by simply rotating the needle 180 degrees fromthe visualization position to the “treatment” position.

Alternatively to preserve a uniform energy field, a substance may beplaced within the notches that provides a tissue interface within thenotches to reflect the ultrasound beam, but does not interfere with theenergy field deposition. Any air within the notches would affect theuniformity of the energy field more than most other substances, andfilling the notches with a substance that would displace the air whileproviding for enhanced reflectivity of the ultrasound beam anddelivering a uniform field of energy to the field would be optimal.Since the reflectivity is a product of the angle of the notches withinthe needle and the dissimilar interface between metal of the needle andthe substance within the notches, the substance that fills the notchesshould be as much unlike the metal needle as possible. A gel may fillthese requirements, as may any one of a number of substance includinghydrogels, polymers, synthetics, hydrophilic plastics, and the like.

Moreover the electrical conductivity properties of the substance thatfills the notches should be as much like the metal needle or probe aspossible so as to deliver the energy field in a manner as close to themetal needle or probe as possible. Hence, the substance within thenotches may contain certain ions or chemicals that enhance electricalconductivity or energy transference.

In another embodiment, an inner stylet may conduct the energy throughthe outer ultrasound visible sheath of the needle and the energydeposited by the inner stylet. This would solve the problems of the nonuniform energy field caused by the notches, but may cause the overallsize of the needle to be larger to accommodate the inner stylet and theouter sheath.

In still another embodiment, it may be advantageous to insulate theouter surface of the needle with a non-conductive substance and transmitthe radiofrequency current, electrical current, or other energy alongthe shaft of the needle to a location not covered by the insulatingmaterial. This would allow the energy to be administered only at the tipof the needle, or at some other predetermined location along the needleshaft that did not have the insulating material. In a preferredembodiment, the insulating material may also comprise reflectiveproperties so that the insulating material also aids in reflectivity. Instill another embodiment, a reflective material is deposited into thenotches to enhance ultrasound visibility and the insulator material isapplied over the wall of the needle also covering the notches containingthe aforementioned reflective material.

One particular use for the device of the current invention or any otherneedle for that matter is to utilize it in renal denervation to controlhypertension. It has been shown that by delivering radiofrequency pulsesor other energy sources to the renal arteries via a catheter in therenal arteries, that the radiofrequency (RF) pulses or other energydamage the nerve fibers that are located just outside the renal artery.The damage is enough to diminish the nervous system stimulation to thekidneys and thereby diminish the nervous, hormonal and humoral pathwaysthat have caused the hypertension. This system, termed “renaldenervation,” is effective, but requires an invasive catheterization ofthe arterial system. Another method of renal denervation involvesimaging the renal artery with ultrasound, placing a cannula or the sortadjacent to the renal artery and delivering RF or other energy to theperiarteial space containing the nerve fibers through the needle. Theprocess is then repeated on the contralateral side. This has not beendescribed before and is an invention in its own right.

The device of the current invention may be used to deliverradiofrequency or other pulses to the soft tissue and nerves adjacent tothe renal artery by using ultrasound guidance. The means for retainingultrasonic reflective material within the notches or indentations willdramatically improve the ease at which the needle can be guided intoappropriate position for the delivery of the energy. The placement ofthe needle needs to be precise and the reflectivity of needles withoutthis feature will be problematic in that they will not be easilyvisualized.

The present invention may be a surgical needle visible to ultrasoundcomprising: a generally cylindrical, commonly tubular structure andhaving an axis, said structure having at least one notch, said notchhaving a first face that reflects ultrasound and a means for retainingultrasonic reflective material to enhance the reflectivity of theultrasound. The notch may be located only on one side of the needle. Thesaid notch may comprise indentations which enhance ultrasoundreflectivity.

The tubular structure is solid or the structure comprises a sidewallcontaining a lumen. The notch may comprise a substance withsubstantially different echogenicity than the needle. The notchcomprises a substance with substantially the similar energy conductivityproperties as the needle. The surgical needle of the current inventionmay be a tubular structure and having an axis, said structure having atleast one notch, said notch having a first face that reflectsultrasound, and said notch comprising indentations within the floor orsidewall of said notch. It may comprise a means for entraining small airbubbles within said indentations. There may be reflective material inthe notch comprised of one of air or other reflective material. Thenotch of the needle may be comprised of a face of one of either anacute, right, or obtuse angle. It may have an indentation whose depthreplaces a substantial portion of the needle sidewall. The notch mayhave either indentations or ridges or both to entrail air bubbles.

Energy may be delivered through the needle of the current invention anddeposited into tissue. The energy may be radiofrequency energy,irreversible electroporation, radiation, focal ultrasound, heat,cryotherapy, or other energy.

The present invention may be utilized in method of depositing energyinto tissue wherein the tissue to be treated is localized by theechogenic enhancing properties of the device, and energy is deliveredthrough the device and the device removed. Also a method of depositingenergy into tissue utilizing the device of the current invention whereinthe tissue to be treated is localized by the echogenic enhancementproperties of the device, the device is rotated 180 degrees, and theenergy is delivered through the device and the device removed. A methodof renal denervation comprising placing a needle or cannula underultrasound guidance adjacent to the renal artery, delivering an energysufficient to damage the nerves adjacent to the renal artery, andremoving the needle is described herein.

While the above descriptions have been directed toward enhancingultrasound reflectivity while depositing energy fields to treat tumors,the above devices and methods may be utilized to deposit any type ofenergy for other applications including but not limited to nervestimulation, nerve blocks, coagulation, ablation, treatment of vascularlesions, thrombolysis, prevention of restenosis, excitation ofmicrospheres, and the like.

While the present invention is disclosed by reference to the preferredembodiments and examples detailed above, it is to be understood thatthese examples are intended in an illustrative rather than in a limitingsense. It is contemplated that modifications and combinations will occurto those skilled in the art, which modifications and combinations willbe within the spirit of the invention and the scope of the followingclaims.

What is claimed is:
 1. A surgical needle visible to ultrasoundcomprising: a tubular structure and having an axis, said structurehaving at least one notch, said notch having a first face that reflectsultrasound and a means for retaining ultrasonic reflective material toenhance the reflectivity of the ultrasound.
 2. The surgical needle ofclaim 1, wherein: the notch is located only on one side of the needle.3. The surgical needle of claim 1, wherein: the tubular structure issolid.
 4. The surgical needle of claim 1, wherein: the structure is atubular structure comprises a sidewall containing a lumen.
 5. Thesurgical needle of claim 1, wherein: the ultrasonic reflecting materialcomprises a substance with substantially different echogenicity than theneedle.
 6. The surgical needle of claim 1, wherein: the ultrasonicreflecting material comprises a substance with substantially the similarenergy conductivity properties as the needle.
 7. A method of depositingenergy into tissue utilizing the device of claim 1, wherein: the tissueto be treated is localized by the echogenic enhancing properties of thedevice, and energy is delivered through the device.
 8. A method ofdepositing energy into tissue utilizing the device of claim 1, wherein:the tissue to be treated is localized by the echogenic enhancementproperties of the device, the device is rotated 180 degrees, and theenergy is delivered through the device.
 9. The surgical needle of claim1, wherein: energy is delivered through the needle and deposited intotissue.
 10. The surgical needle of claim 1, in which the energydelivered is irreversible electroporation.
 11. The surgical needle ofclaim 1, wherein: the notch comprises a substance with substantiallydifferent echogenicity than the needle and similar energy conductivityproperties as the needle.
 12. A surgical needle visible to ultrasoundcomprising: a tubular structure and having an axis, said structurehaving at least one notch, said notch having a first face that reflectsultrasound, and said notch comprising indentations within the floor orsidewall of said notch.
 13. The surgical needle of claim 12, comprising:a means for entraining small air bubbles within said indentations. 14.The surgical needle of claim 12, comprising a notch, said notchcomprising indentations which enhance ultrasound reflectivity.
 15. Thesurgical needle according to claim 1, wherein said reflective materialcomprises at least one of air or other reflective material.
 16. Asurgical needle visible to ultrasound comprising an indentation thatcomprises a means of retaining air within the indentation to enhancereflectivity.
 17. The needle of claim 16, which comprises a face of oneof either an acute, right, or obtuse angle.
 18. The needle of claim 17,which comprises an indentation whose depth replaces a substantialportion of the needle sidewall.
 19. A method of renal denervationcomprising placing a needle or cannula under ultrasound guidanceadjacent to the renal artery, delivering an energy sufficient to damagethe nerves adjacent to the renal artery, and removing the needle.